Elderly American Indians and Alaska Natives and Cardiovascular Risk Reduction

Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives and is rapidly increasing in prevalence. CVD is known to be affected by dietary habits as well as levels of physical activity. Many American Indians and Alaska Native elders have increasingly high rates of high fat diets as well as sedentary lifestyles. Recent evidence suggests that exercise and dietary changes benefit CVD risk profiles among elderly persons as well as younger persons. However, little data exist regarding such changes among older American Indians, particularly among urban dwellers.

Specific Aims:

To implement and evaluate a dietary and exercise program specifically for older, urban dwelling American Indian and Alaska Native elders, assess knowledge, attitudes, behaviors, and beliefs regarding diet, exercise and CVD among this group, and to identify potential barriers to changes in diet or exercise. Proposed Methodology:

This pilot study will evaluate the effects of a combined exercise and dietary instruction program using a randomized cross-over control design. Pilot study subjects will be recruited from overweight, sedentary American Indians and Alaska Natives ages 50 and above who are clients of the Seattle Indian Health Board (SIHB) and who have no know restrictions on physical activity. A recent review of medical records of 553 SIHB clients at least 50 years of age revealed high prevalence rates of CVC risk factors, including hypertension (38%), and obesity (49%).

The interventions will consist of 8 weekly meetings incorporating physical activity instruction interactive discussions, and written information regarding cardiovascular disease and its risk factors. Two groups of 15 elders will be enrolled: one group will begin the eight-week course and the other will only receive written information. After eight weeks, the second group will begin the weekly classes, with the first group receiving written information only. Data collection will include demographics such as age, gender, education, language, personal and family income, family size and smoking history at the beginning of the study. Other information will be collected at baseline, at 8 weeks, and again at 16 weeks for all participants and will include knowledge, attitudes and behaviors regarding CVD as well as exercise habits, smoking habits, 4-dayfood records, body image, medical skepticism, self-reported chronic diseases, self-reported health status, self-reported functional status, and depression scale. Barriers to lifestyle changes such as control of meal preparation, access to transportation, and perceived safety barriers to exercise will be sought. Clinical outcome information will also be collected on all participants at baseline, 8 weeks, and 16 weeks and will include measurements of weight, height, blood pressure, BMI, percent body fat, waist-to-hip ratio, and exercise efficiency using the Sallis Step Test. Changes in these various factors will be analyzed using both descriptive and multivariate techniques.

Proposed Analyses:

Data obtained from this study will help determine the ability of a behavior modification program to attract older American Indians and Alaska Natives. Factors promoting or preventing elders from improving their cardiovascular fitness will be determined. If significant improvements are found, a larger study to evaluate the independent or synergistic effects of these changes upon other independent CVD risk factors, including diabetes, will be implemented. Findings will help Indian health programs to expand services to improve the health of older urban dwelling American Indians and Alaska Natives.